The Application of the Lamaze Method in the Management of

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The Application of the Lamaze Method in theManagement of Acute Pain: A Comparison ofNon-pharmacological Pain ManagementTechniquesEmily Marie [email protected]

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THE APPLICATION OF THE LAMAZE METHOD IN THE

MANAGEMENT OF ACUTE PAIN:

A COMPARISON OF NON-PHARMACOLOGICAL PAIN MANAGEMENT

TECHNIQUES

A Dissertation submitted to the

Graduate College of

Marshall University

In partial fulfillment of

the requirements for the degree of

Doctor of Psychology

Psy. D. Program, Department of Psychology

by

Emily Marie Selby-Nelson

Approved by

Dr. Marc Lindberg, Committee Chairperson

Dr. Marianna Linz

Dr. Daniel McNeil

Marshall University

August 2011

ii

Dissertation Acknowledgments

It is a pleasure to thank those who made this dissertation possible. I owe my

gratitude to my dissertation chairman, Dr. Marc Lindberg, who provided me with a

perfect balance of autonomy and guidance. His willingness to share his knowledge and

proficiency in the field researched created an encouraging and supportive working

environment. In addition, I would like to express my appreciation to my committee

members, Dr. Marianna Linz and Dr. Daniel McNeil. Their enthusiasm and support

during the progression of my dissertation was most helpful and motivating. They both

provided expertise that advanced my understanding of the research to another level. I

would also like to thank the generous undergraduate researchers who helped in data

collection. Finally, I would like to thank my husband, family, and friends for their

continued and unwavering support throughout my years of study and research. Their

patience and encouragement will forever be appreciated.

iii

Table of Contents

Dissertation Acknowledgments…………….………………………………………........ ii

List of Tables…………………………………………………………………………..... iv

List of Figures……………………………………………………………………………. v

List of Appendixes……………………………………………………………………..... vi

Abstract ……………………………………………………………………………….... vii

Introduction ……………………………………………………………………………… 1

Methods ……………………………………………………………………………….... 12

Results ………………………………………………………………………………….. 18

Discussion …………………………………………………………………………….... 19

References …………………………………………………………………………….... 66

Curriculum Vitae .…………………………………………………………………….…69

iv

List of Tables

Table 1: Summary of Protocol by Group ...……….……………………………………22

Table 2: Pre and Post Pain Management Duration by Group .………………………… 23

Table 3: Descriptive Statistics for Mean Practice Time (in minutes) by Group …..…... 24

v

List of Figures

Figure 1. Mean Pain Management Ability (duration in post pain task) by

Group ……………………………………………………………………………26

vi

List of Appendixes

Appendix 1: Demographics Form ......………………………………………………….. 27

Appendix 2: Pain Rating Scale ...………………………………………………………. 29

Appendix 3: Anxiety Rating Scale …………………………………………………….. 30

Appendix 4: Long Lamaze Group Protocol ……………………………………………. 31

Appendix 5: Brief Lamaze Group Protocol ………………………………………….… 41

Appendix 6: Control Group Protocol …………………………………………………... 46

Appendix 7: Acceptance Group Protocol …………………………………………...…. 55

Appendix 8: IRB Approval Letter ……………………………………………………... 65

vii

Abstract

The Application of the Lamaze Method in the Management of Acute Pain:

A Comparison of Non-pharmacological Pain Management Techniques

Emily Marie Selby-Nelson

Pain is a primary concern in health care. Considering the limitations of pharmacological

interventions, identifying the effectiveness of alternative pain management is crucial.

Utilizing a pre-post design, different psychological approaches to acute pain management

were tested. Participants included 85 college females who were randomly assigned to one

of four conditions (Long Lamaze, Brief Lamaze, Acceptance of pain, and a Control

group). Participants first underwent an Algometer pain task, then received training or

control interactions once a week for four weeks, and were tested again on the pain task.

Amount of time participants were able to withstand the pain administered in the

Algometer tasks revealed significant differences in pain management across groups from

pre to post testing. There was a significant main effect for Group as well as a significant

interaction between Time and Group showing that change scores were greater in the

Lamaze group than in the Control group These findings and methodologies may help

direct future research toward the application of alternative pain management techniques.

1

Introduction

Pain is one of the most common presenting problems motivating patients to seek

consultation from medical professionals in the United States (Nawar, Niska, and Xu,

2007). The economic impact of pain management has effects on patients, their providers,

and society (Loeser, 1999). For example, pain as a health condition has resulted in a loss

of productivity equivalent to approximately $61 billion per year in the USA (Cheatle &

Gallagher, 2006). Individuals who experience acute or chronic pain on a regular basis are

likely to experience additional stress regarding disability and limitations pertaining to

their ability to work, function daily, and maintain general physical and mental well-being.

These effects appear to be exacerbated in rural America where individuals may have

limited access to costly pharmacological pain management (Kaulagekar & Radkar, 2007).

The treatment that is most often suggested to a patient in pain is pharmacological

intervention (Turk & Burwinkle, 2005). Pharmacological pain management includes

various types of medications that fall into the following five groups: (a) narcotics (or

opioids) typically used to treat short-term acute pain; (b) muscle relaxants used to treat

contractions and muscle spasms; (c) non-steroidal anti-inflammatory medications

(NSAIDs) for pain and related inflammation; (d) sedatives for improved sleep; and (e)

analgesics (e.g., paracetamol, or acetaminophen; non-steroidal anti-inflammatory drugs,

and tramadol) that are used to treat long-term pain and control frequently occurring pain

symptoms (Turk & Burwinkle, 2005).

Although these medications are often effective in the treatment of pain, they do

not directly address other issues that contribute to the overall distress that many

individuals in pain experience. These other issues may include anxiety, a low perception

of health locus of control (the extent to which an individual believes he or she is able to

2

control his or her own health), a decrease in self-efficacy and confidence regarding

coping, inactivity, and behavioral avoidance (Hanson, 2000). In addition, patients who

are offered pharmacological treatments for pain rarely obtain sufficient training in pain

management skills due to the frequent inadequate nature of practitioner knowledge

regarding pain management (Seers, Watt-Watson, & Bucknall, 2006).

Other problems associated with pharmachological approaches to pain can have

other negative outcomes as well. These problems can extend from patient non

compliance (missing doses and accidental overdoses), to a lack of interpersonal medical

support, to a decrease in self-efficacy (i.e., feelings of lack of control and inability to

cope), and finally, to addiction, and substance abuse (Turk & Burwinkle, 2005). Hojsted

and Sjogren (2007), in their review of the opiod pain management literature, found

estimates of the development of opiod addictions ranging between 0 and 50%. Although

it is difficult to estimate what the actual rates are (Ballantyne, 2007), such drug therapies

have raised concerns about the use of such potentially addictive medicines. This risk is

further complicated by the fact that it is difficult, if not impossible, to predetermine those

patients who might misuse or abuse prescription pain medications (Gourlay, Heit, &

Almahrezi, 2005).

Considering the numerous limitations of pharmacological pain management, the

importance of identifying the effectiveness of alternative cognitive, affective, and

behavioral pain management treatments cannot be understated. Unlike pharmacological

interventions, such treatments might better offer support and training that address and

optimize self-efficacy and personal control regarding health and symptom management.

3

Further, such techniques might be used in conjunction with medicines as a way to wean

patients off the more addictive drugs.

Alternative and complementary psychological therapies have been reported to

generally reduce pain and the need for pharmacological intervention (Field, 2008).

Because these psychological treatments do not typically involve the administration of

medications, drug addiction problems are reduced or eliminated. Because

complementary and alternative techniques frequently require contact with a trained

practitioner, interpersonal medical support is also provided. Likewise, the patient‟s

active participation and acquisition of self-help skills in these techniques is theorized to

reduce the likelihood of a lack of self-efficacy. Turk and Feldman (1992) identified self-

efficacy as an important psychological factor in the experience of pain.

According to De Jong and Gamel (2006), alternative and complementary

treatments such as relaxation offer low-risk, easy to learn, and independently achieved

techniques that supplement the pain management offered by medical practitioners.

Alternative and complementary therapies include, but are not limited to, the following:

relaxation, mindfulness, biofeedback, massage therapy, and acceptance (Field, 2008).

Other researchers have suggested additional interventions to be effective in the treatment

of pain, including distraction (Wiederhold & Wiederhold, 2007), exercise (Dogan et. al.,

2008), and cognitive-behavioral interventions that target the cognitions surrounding pain

experiences (Turk, Swanson, & Tunks, 2008).

According to Loeser (1999), pain management may contribute to a number of

beneficial outcomes including a reduction in symptoms, as well as a reduction in the

costs for the individual, society, and our health care system. Loeser (1999) suggests that

4

the most efficient and effective model of pain management would be a biopsychosocial

model wherein an individual‟s cognitive resources, environment, and biological health

status are all taken into account and integrated into a holistic treatment model.

Alternative and complementary interventions offer a solution to the need for a

biopsychosocial model of pain management.

However, in the experimental evaluation of such techniques, it is problematic that

the methodologies have generally used questionable controls in their design and have had

great variation in the pain experiences measured. Such methodological limitations lead

to the question, “What should serve as an appropriate control?” Does an untreated

control constitute an experimentally valid control (Rescorla, 1967)? How has one ruled

out possible placebo effects? How has one attempted to control for the same quality of

pain between all the participants? It was the purpose of the present design to correct for

many of these short comings in this literature.

The Lamaze Technique

One technique that has not been widely studied in recent years as a method for

pain management is the Pavlovian Psychoprophylactic Method also known as the

“Lamaze method” (Lamaze, 1970). Because Lamaze (1970) most clearly documented

the rise, development, and utilization of this method in France, it is important to discuss

his text, Painless Childbirth: Psychoprophylactic Method (1970). According to Lamaze,

Pavlov first tested hypnosis as a way to cope with pain as it was initially considered the

predominant alternative pain management technique applied in medical settings in the

late 1800s. Lamaze (1970) noted that Pavlov reasoned that hypnosis was limited in that it

included a passive role for the mothers as well as the large individual differences found in

5

hypnotic susceptibility. Despite the initial popularity of applying hypnotic suggestion to

pain management, the method failed to be established as a reliable method, and Pavlov

and his students searched for a more effective set of techniques. These techniques were

termed the Pavlovian Psychoprophalactic Method of Birth, and when Marjorie Karmel

(1959) wrote Thank you, Dr. Lamaze, it was called the Lamaze technique thereafter.

The “Lamaze” or Pavlovian Psychoprophalactic Method of birth was based on

Pavlov‟s theory of counter conditioning (Lamaze, 1970). In counter-conditioning

paradigms, a second incompatible response is conditioned to a previously conditioned

stimulus (the first response). Lamaze (1970) gave the following example of a counter-

conditioning design out of the Russian laboratories. Lamaze (1970) recounted a study by

Rogov performed in 1953 wherein Rogov first paired a bell to a (43 centigrade degree)

stimulus to the forearm. This procedure created the conditioned response of

vasodilatation and a pleasant sensation of warmth to the forearm when only the bell was

sounded. After several conditioning trials, Rogov said, “I am going to ring the bell,” but

presented 65 degrees centigrade to the forearm. (It should be noted that in unconditioned

participants, 65 degrees (about 149 F) produces vasoconstriction and a very strong

perception of pain.) The conditioned participants did not show vasoconstriction and pain

responses to the 65 degree stimulus, but rather, responded with vasodilatation and the

pleasant perception of warmth. This outcome was a clear demonstration that counter

conditioning was successful in the elimination of pain and basic physiological pain

responses. (It should be cautioned, however, that this study was a secondary source, the

result has not been replicated, and we are uncertain of the details of the methods and

control groups.)

6

In the Lamaze method, relaxation, staring at a focal point, and breathing patterns

were used as conditioned responses. Repetition, or conditioning, was said to be a key

element in this conditioning process and was noted to strengthen the secondary

conditioned responses to images of contraction elicited by a coach utilizing what Pavlov

considered to be the second signal system of language. It should be noted that the focal

point should be selected such that it already produces feelings of well-being, thus

carrying sensory preconditioning to the conditioning session.

Since the Lamaze method‟s introduction, research (although limited) has

supported its application. Klusman (1975) conducted a study observing the effects of

participation in Lamaze childbirth courses in a study comparing a control group with a

Lamaze group. It was found that those individuals who received education and training

in Lamaze experienced a reduction in fear and anxiety and consequently experienced a

reduction in pain. Mood and pain perception have both been found to be improved in

individuals who received training in the Lamaze method (Leventhal et. al., 1989).

However, the “do nothing control” group employed in these studies did not allow one to

determine just why the differences occurred. (See Rescorla (1967) for a discussion of

appropriate controls in conditioning paradigms.) The effects could have been produced

from education, relaxation, the focal point, the formation of counter-conditioned

responses, or mere interaction with the “coaches” in a safe secure environment.

A number of modern clinical approaches were anticipated by the Lamaze method.

As applied to childbirth, these methods typically consist of giving instruction pertaining

to the nature and process of labor and delivery (psychoeducation related to pregnancy and

7

birth), visual focusing (meditation), breathing techniques, muscle relaxation, the use of a

training coach (social support), and cognitive restructuring (Wideman & Singer, 1984).

Distraction as used in pain management has been demonstrated to be effective in

reducing pain (Dahlquist, McKenna, Jones, Dillinger,Weiss, & Ackerman, 2007).

Distraction, as used in the Lamaze method, is introduced to help to divert a participant‟s

attention from the pain she is experiencing by requiring the patient to concentrate on her

breathing patterns and a focal point. It may be effective because pain perception requires

attention for the perception to occur and because, at any one time, there is a limited

amount of attention that may be placed on one situation (McCaul & Malott, 1984).

Visual focus and active breathing maintain attention by having individuals actively

participate in a purposeful, deliberate behavior.

Breathing, as a form of relaxation, has been theorized to decrease pain perception

(De Jong & Gamel, 2006). Breathing relaxation is a form of focused rhythmic breathing

that has been shown to slow mental and physical activity in order to reduce responses of

the sympathetic nervous system (Kwekkeboom & Gretarsdottir, 2006). The Lamaze

method includes advanced breathing techniques. The method involves the use of deep

and slow breaths that help to relax individuals by increasing oxygen and decreasing

tension. The Lamaze method also includes a breathing pattern wherein individuals take

short shallow breaths. These shallow breaths increase and decrease in repetition patterns

called breathing pyramids.

Progressive muscle relaxation, another key element of the Lamaze technique, is a

form of relaxation that aims to physically and mentally reduce body tension. Progressive

muscle relaxation is used during Lamaze training to teach individuals how to relax and to

8

identify the distinct differences between sensations of tension and relaxation. Subjects

learning progressive muscle relaxation are trained to isolate each muscle body area (head,

face, neck, shoulders, arms, chest, stomach, buttocks, legs, and feet) by focusing their

attention on each area and simultaneously tensing each area for several seconds and then

relaxing the specific area. When compared to other interventions, progressive muscle

relaxation has been found to be more effective and to contribute to pain and distress

reduction by reducing the amount of tension experienced by individuals (Kwekkeboom &

Gretarsdottir, 2006).

Visualization is the use of a focal point that helps individuals relax, refocus, and

visualize a representation of an object or symbol that is relevant and meaningful.

According to Turk, Swanson and Tunks (2008), guided imagery and visualization may

help individuals in pain to achieve a sense of control, relax, and distract themselves from

pain perceptions. This visualization is said to aid in pain management by guiding the

focus away from the experience of pain and onto a stimulus that has previously prompted

a relaxed and positive sensation or feeling.

Social support has also been identified as a contributing factor in the successful

management of medical illness and pain reduction. According to Hurwitz, Goldstein,

Morgantern, and Chiang (2006), high levels of social support were found to be related to

clinical reductions in pain and disability. The support of others encourages patients to be

motivated toward treatment and recovery and may minimize isolation and hopelessness.

The Lamaze method utilizes social support in the form of coaches who offer support and

collaboration in pain management efforts.

9

Although the Lamaze method has remained in continuous use and its

subcomponents have been emphasized in research, it seems surprising that there has been

a reduction in both the number of individuals utilizing this method and in the emphasis

given to this method by practitioners in preparing women for childbirth (Strote, 2007).

Most research in the field of Lamaze has also diminished and is now dated, and most of

the original studies were merely correlational. Current practices in Lamaze have also

changed since its original introduction. The Lamaze method is now offered in a number

of formats, including a series of classes (traditional Lamaze classes), brief training

modules (one training session), and brief review in general birth preparation classes.

Many courses are also directed toward both parents and prepare families for birth and

parental life in general. Although there are few traditional Lamaze options, a more

general philosophy of Lamaze continues to be applied in birth settings.

Could the Lamaze method be applied to general acute pain and its application

broadened to other areas of pain management? Given that the Lamaze method combines

reportedly effective techniques that have been theorized to be efficient and reliable, it was

considered worthwhile to test its effectiveness. However, it was deemed necessary to

disentangle the utilization of these techniques with additional tests in order to explore the

assumption that conditioning trials are necessary to the Lamaze technique‟s supposed

success.

Acceptance of Pain

The above techniques are not the only psychological interventions that have been

proposed as effective in the treatment of pain. Acceptance is an established pain

management technique that has been used to assist individuals through chronic pain

10

(Hanson, 2000). Acceptance as a pain management procedure includes directing

attention toward values and goals (exercise, attending events, etc.) rather than focusing

on the experience of pain. Acceptance of pain as a normal experience leads individuals

to shift their attention toward meaningful goals and encourages individuals to act in spite

of pain. Acceptance of pain serves as a contrast to the philosophy of the Lamaze method.

Although the Lamaze method contains techniques designed to decrease pain perception,

acceptance offers a different approach that embraces pain as a normal experience and

does not focus on the elimination of pain. Thus, because acceptance has been promoted

as one of the newer and more successful cognitive strategies in the psychological

literature, it was selected as an important contrast group to include in the proposed study.

If the older Lamaze technique is inferior to the newer techniques, then it is only of

academic and not pragmatic significance to determine why the Lamaze technique works.

If, however, it is superior to the newer techniques, then its continued study and use is

more than warranted in the general literature of pain management.

Study Design and Logic

Integrating traditional Pavlovian methodologies and approaches to pain reduction

with modern clinical techniques affords several methodological and conceptual

advantages. A basic strength of conditioning approaches is that they afford several

precise ways of analyzing which psychological mechanisms mediate the effectiveness of

conditioning techniques. These methods may be superior to many traditional clinical

methodologies that merely involve traditional pre-post designs or compare an

experimental group with a control group that does not receive treatment. Thus, their

11

weakness is that they do not specify which psychological mechanisms are necessary and

sufficient conditions for producing change.

Methodological sophistication is a cornerstone of conditioning research. Rescorla

(1967) dealt with these issues identified in the conditioning literature. Rescorla was

interested in determining what constitutes an appropriate control group to demonstrate

that “conditioning” has occurred. According to Rescorla (1967), the control groups

previously proposed were inadequate in that they unsuccessfully attempted to control for

nonassociative effects. Rescorla suggested that a “true control” should retain as many

possible aspects of the experimental procedure while excluding the CS-US contingency.

Thus, traditional “do nothing” control procedures and ABA designs were not deemed

appropriate for the evaluation of classical conditioning effects.

The above discussion leads to two very different sets of hypotheses. The

conditioning hypothesis, on the one hand, would predict that participants in the Long

Lamaze condition would show the greatest pre-post differences in pain tolerance. The

conditioning hypothesis would also predict that the Short Lamaze and Acceptance

conditions would be inferior to the Long Lamaze condition, but superior to the Rescorla

control if they are effective pain management strategies with specific mechanisms of

change. This prediction is based on non-associative placebo effects wherein participants

dealt with pain in the context whereas the Rescorla control did not. The acceptance

hypothesis, on the other hand, would predict that focusing on and actively dealing with

the pain as in the two Lamaze conditions might lead to lower pain tolerance scores than

the Rescorla control. In addition, the Rescorla control would be inferior to the

12

Acceptance group which would produce the greatest increases in pain tolerance by

having participants focus on it.

Method

Participants

Female participants were recruited from a University introductory psychology

research pool and included 151 individuals. They were offered reimbursement for their

participation in the form of extra credit for their course. Participants averaged 18 years of

age with a range of 18 to 38. Participants were female in order to remain consistent with

other populations who have applied Lamaze in pain management and to eliminate

possible sex differences in the data. Participants who lasted longer than 5 minutes on the

first pain task with the Algometer were dropped from the study, resulting in the exclusion

of 26 participants. This procedure was included to eliminate ceiling effects and to

minimize the occurrence of habituation to pain stimuli and to avoid any potential risk for

tissue damage to participants who would pass the suggested five-minute pain task

duration. Participants were also dropped if they did not attend subsequent sessions,

resulting in 40 participants being eliminated in this study. Eighty-five participants

completed the study.

Trainers

The trainers included the senior author and eight senior-level psychology students

receiving credit for a senior capstone research seminar. Trainers were trained in the

Lamaze technique by a nurse at a local hospital who specialized in the Lamaze Technique

as well as childbirth education or by the senior author. Training in Lamaze consisted of a

two-hour training session followed by repeated practice. They also were trained in

13

Acceptance by the senior author. This Acceptance training consisted of familiarizing

researchers with general concepts of acceptance as a cognitive intervention through

readings, discussions, and demonstrations (Hayes, Strosahl, & Wilson, 1999). Each week

during the study period, the trainers met as a group and were briefed in one-hour sessions

on each week‟s protocol. They were provided with scripts and written protocols to

review and use in each session.

Apparatus

Because of the variability in pain experiences, a study of pain coping requires the

production of consistent pain experiences across participants. The Algometer pressure

device has been used as a way of analytically producing pain and acts as a dependent

variable that can make the analytic study of therapeutic mechanisms possible (Rainwater

& McNeil, 1991). The Algometer pressure device is an apparatus that places a weighted

wedge on the middle finger of a participant‟s non-dominant hand (Rainwater & McNeil,

1991). The blade of the plastic wedge is placed over the participant‟s finger and a weight

is placed on top of the wedge. This procedure produces a building acute pain experience

until the participant cues for the procedure to end when he or she has reached his or her

pain threshold (limit of ability to cope with the pain). During the pain task used in this

study, a weight of 750 grams was used during a pain task with a time limit of five

minutes. According to Rainwater and McNeil (1991), individuals may become

habituated to pain experiences after five minutes. If this were to occur, there would be a

potential for participants to last beyond the point of habituation, creating ceiling effects

making it difficult to assess pain tolerance past that time period. In addition, the five-

14

minute time limit was enforced to avoid possible harm to participants who might last

longer than five minutes.

Procedures

Participants were divided into four groups: (a) 21 individuals receiving long

Lamaze training, (b) 19 individuals receiving brief Lamaze training, (c) 25 individuals

receiving training in acceptance, and (d) 20 individuals serving as a control. The four

research groups were counterbalanced with each trainer conducting training sessions with

participants from each of the overall groups. Each trainer carried out his or her own

schedule wherein he or she conducted weekly one-hour sessions for each of the four

groups for five weeks. The overall four groups were broken down into smaller groups

that typically included three to five participants in order to allow for more manageable

and effective training. Participants were reminded of their sessions through e-mail.

Participants were instructed to complete demographic questionnaires and

informed consents on the first day (see Appendix 1). Participants‟ history and current

experiences of acute and chronic pain were collected. Participants were taken one at a

time to a different room where they were tested on the Algometer. During each pain task

(pre and post) participants were instructed to use a Likert-scale rating (0=no pain to

5=most possible pain experienced) to indicate pain perception (see Appendix 2). They

also were instructed to use a Likert-scale rating of anxiety similar to the above to note

their level of anxiety (see Appendix 3). These measures were taken before and after each

pain task to observe participants‟ expected and actual pain and anxiety ratings. To assess

pain tolerance, participants were instructed to terminate the pain task by touching a

laminated stop sign when the pain that they experienced became unbearable or reached a

15

degree in which they would stop a painful situation in their actual life. Pain tolerance and

ability to manage pain were defined by the duration of time that passed before a

participant chose to have the weight removed from their finger. The researchers of this

study did not assess pain threshold because the potentially intrusive act of reporting

threshold during the pain task would interrupt any active coping strategy, thereby

providing a confound to the training conditions.

The present study utilized pre-post design wherein participants first participated in

an Algometer pain task, received training or supportive interaction, and then went

through the same pain task after training. Participants were randomly assigned into four

groups, each of which included specific protocols (see Table 1) as follows:

Psychoprophylactic Lamaze method (G1): In this condition, participants

obtained training in Lamaze techniques including the use of focal points, patterned

breathing, and progressive muscle relaxation. In the first session and as with all

conditions, participants were first tested on the Algometer pressure device. In addition to

the above-mentioned surveys and consents, participants also received information about

the use of focal points in pain management. They were encouraged to practice and bring

in a focal point for the following session. In Session two, they reviewed the use of focal

points, received information on patterned breathing, and progressive muscle relaxation,

and performed in-session practice exercises. They were encouraged to practice these

skills each day until the following session. In Session three, participants reviewed and

completed in-session practice exercises of focal point use, patterned breathing, and

progressive muscle relaxation. They were again encouraged to practice these skills

between this session and the next. In Session four, participants reviewed and completed

16

in-session practice exercises of focal point use, patterned breathing, and progressive

muscle relaxation. They were encouraged to practice these skills between this session

and the next. In Session five, participants again filled out surveys and were tested again

on the Algometer. During this procedure, however, participants were instructed to use

the Lamaze techniques that they had practiced over the previous sessions. They were

instructed to utilize these techniques when coping with pain during the final Algometer

procedure. A more thorough description of this protocol is outlined in Appendix 4.

Brief Lamaze method (Group 2/G2): In this condition, participants received

college and career advising during the first three sessions, followed by one Lamaze

training session, and then went through the final Algometer procedure with instructions

analogues to Group 1. In Session 1 (week 1), participants completed the Algometer

procedure and were encouraged to bring in ideas for discussion (topic: academic majors).

In Session 2 and 3, participants collaboratively discussed majors and related information.

During the first three sessions, participants were encouraged to practice focusing on their

major and related concepts between sessions. In Session 4, participants received brief

training in the Lamaze method that included the use of focal points, patterned breathing,

and progressive muscle relaxation and encouraged to practice this last week. During the

final session (fifth session), the participants in this group were instructed to utilize the

Lamaze method in their efforts to manage acute pain during the Algometer procedure. A

description of the procedural protocol for this group is outlined in Appendix 4.

“Rescorla Control” group (Group 3/G3): According to Rescorla (1967), the

appropriate control for conditioning is a group that receives all of the same fundamental

elements of the conditioning episodes (in this case, the Psychoprophylactic Lamaze,

17

group one) but lacks overt pairing with the Unconditioned Stimulus (pain task). In this

study, the “Rescorla Control” participants received the same four weeks of Lamaze

training, learning deep breathing, breathing patterns, focal point use, and progressive

muscle relaxation, but they were not prompted to pair this training with future pain

management and were told the training would be used for general stress management.

Participants in this group also received a final Algometer test; however, they were not

instructed to use the Lamaze training or to integrate in their efforts to manage pain during

the Algometer procedure. Therefore, the control group received Lamaze training without

being paired with pain management for the final pain task. A thorough description of the

procedural protocol for this group is outlined in Appendix 5.

Acceptance group (Group 4/G4): Participants in this group used acceptance as a

pain management technique. Identical to the above three groups, participants were tested

on the Algometer pressure device and filled out surveys on the first day. They then

received four sessions of training in acceptance as recommended by Vowles and

McCracken (2008). During Sessions 1, 2, 3, and 4, participants were trained to accept the

presence of pain and stress while minimizing attempts to control or avoid pain. By

accepting pain, participants may be less likely to focus on pain reduction and may

redirect their attention away from labeling the pain as “painful.” In Session 5,

participants were tested in a fashion similar to the above groups except that they were

instructed to utilize the acceptance skills to manage their pain experienced. A thorough

description of the procedural protocol for this group is outlined in Appendix 6.

Participants in all four groups were instructed to practice the interventions that

they had learned during training sessions between meetings. Practice was an important

18

aspect to encourage and monitor due to the importance of practice in learning and

conditioning. Participants recorded the amount of time spent practicing each day by

completing a weekly practice log. The measurement of time was recorded in seconds and

totaled for analyses. Table 3 summarizes the descriptive statistics of overall practice time

for each group.

Results

A 2 (Pre versus Post Test) by 4 (Group) univariate analysis of variance (ANOVA)

with test as the subject factor was conducted to compare pain management training

effectiveness across groups. Preliminary analyses were performed and confirmed the

assumption of normality. A significant main effect for the time one that could withstand

the painful pressure was found, F (1, 81) = 25.71, p < .001, indicating a significant

difference in pain management across groups from the initial pain testing time (M =

85.54, SD = 7.95) to the post-intervention pain testing time (M = 151.93, SD = 14.50).

There was a significant main effect for Group, F (3, 81) = 5.10, p = .003, indicating a

significant difference in pain management between groups. There was also a significant

interaction between Time and Group, F (3, 81) = 3.88, p = .012. A Bonferroni post hoc

analysis was conducted and found the only significant difference to be between the pain

management scores of participants in the Long Lamaze group (M = 178.02, SD = 19.39)

versus the Control group (M = 71.13, SD = 19.87). There were no other significant

differences in pain management across groups. Table 2 summarizes the mean pain

management ability (defined as the time in minutes spent in each pain condition) of

participants in each group during the pre and post pain tasks. Figure 1 summarizes the

differences in pain management (tolerance) by group during the post pain task.

19

Pain experiences including current acute pain, current chronic pain, past acute

pain, and past chronic pain were also analyzed. It was expected that these variables

would predict participants‟ ability to manage pain during the pain task. A linear

regression was conducted to observe the effect that pain experiences had on pain

management ability. Not one of these variables was found to reliably predict pain

management ability, r2 = .024, F (4, 67) = .39, p > .05.

Considering that anxiety has been found to exacerbate pain, the role of

anticipatory anxiety and predictions of painful experiences were also analyzed to

determine its effect on actual reports of anxiety and pain in the context of the present

study. During the pre pain test, anticipatory anxiety was positively related to higher

ratings of expected pain, r(82) = .72, p < .01; actual anxiety, r(81) = .38, p < .01; and

actual pain, r(81) = .38, p < .01. Predictions of higher levels of pain were also positively

related to higher ratings of anticipatory anxiety, r(82) = .72, p < .01; actual anxiety, r(81)

= .28, p < .01; and actual pain r(82) = .45, p < .01. During the post pain test, anticipatory

anxiety was positively related to higher ratings of expected pain, r(83) = .71, p < .01;

actual anxiety, r(83) = .64, p < .01; and actual pain, r(83) = .39, p < .01. Predictions of

higher levels of pain were also positively related to higher ratings of anticipatory anxiety,

r(83) = .71, p < .01; actual anxiety, r(83) = .53, p < .01; and actual pain r(83) = .52, p <

.01.

Discussion

It was found that the subjects who received training in Long Lamaze were the

only group to demonstrate a significant difference in pain management when compared to

the control group. This outcome suggests that training in the Lamaze method improves

20

an individual‟s ability to manage general acute pain at a superior level when compared to

a proper control group. No significant differences, however, were identified between

long Lamaze and the other comparison groups. Although the conditioning hypothesis

predicted (and the trends in the data showed) that the long Lamaze group would

demonstrate superior pain management ability when compared to the brief Lamaze and

acceptance interventions, these differences were not significant. Participants who

received training in acceptance and brief Lamaze skills did not vary from one another on

pain management ability, nor did they differ significantly when compared to the control

group.

Anticipatory anxiety and predictions of high levels of pain correlated significantly

with actual reports of anxiety and pain. Considering this finding, effective treatments

targeting anxiety management may be helpful in minimizing the effects of such anxiety

prior to painful procedures or flares of recurrent acute pain. As mentioned earlier, the

Lamaze method includes a number of techniques that have been successful in treating

anxiety.

The present study had several limitations that may have affected the outcome of

the research. The eight researchers or trainers in this study were undergraduate research

assistants participating to gain experience in research. Such inexperience and variation in

training could have introduced significant amounts of error variance. The most

significant problem in the present design was the lack of practice shown by the

participants. The amount of practice (average of four minutes per day) reported by

participants in the present study was probably not sufficient when compared with the

recommended 30 minutes of practice for 30 minutes a day for 30 days to reach the

21

requirements of conditioning in the Lamaze technique. Conditioning contra-prepared

(Seligman & Hager, 1972) associations such as this typically take several trials to achieve

good conditioning (Kimble, 1961), and it might have been the case that we were

operating at basement effects of “trials” to unequivocally demonstrate conditioning.

Therefore, the weak effects of Long Lamaze might have simply come from lack of

practice. Future research is encouraged to control for these limitations by paying for

participants to return daily for daily practice sessions in order to ensure sufficient

adherence. Further, one also needs to examine whether these techniques can be used with

chronic pain as well.

The present study‟s most important contribution might have been in the

introduction of a research paradigm with appropriate controls to study the claims of

different psychological interventions in pain reduction. Perhaps the most interesting

results came from the Short Lamaze and Acceptance training conditions. Here typical

alternative techniques were not significantly different from the control group. The

amount of practice in these techniques was equal or greater than typically given in similar

interventions in the literature, yet the effects were not significant when compared to

appropriate controls. Thus, claims for such interventions in the treatment of pain need to

be looked at anew, and the present methodology provides specific ways in which this

research might be done. This study also supports the efficacy of the Lamaze method in

the application of general acute pain management. However, further tests of adequate

conditioning need to be assessed. At a minimum, however, this result suggests that this

technique may be beneficial to pain patient populations outside of pregnancy and birth.

22

Table 1.

Components by session:

Groups:

Psychoprophylactic Lamaze Group (G1)

Brief Lamaze Group (G2)

Rescorla Control Group (G3)

Acceptance Group (G4)

Session 1

Algometer

procedure; Lamaze

training: focal point,

progressive muscle

relaxation, and

patterned breathing

training

Algometer procedure; advising/supportive interaction

Algometer procedure;

Lamaze training:

focal point,

progressive muscle

relaxation, and

patterned breathing

training

Algometer procedure; training in acceptance

Session 2

Lamaze training:

focal point,

progressive muscle

relaxation, and

patterned breathing

training

advising/supportive interaction

Lamaze training:

focal point,

progressive muscle

relaxation, and

patterned breathing

training

Training in acceptance

Session 3

Lamaze training:

focal point,

progressive muscle

relaxation, and

patterned breathing

training

advising/supportive interaction

Lamaze training:

focal point,

progressive muscle

relaxation, and

patterned breathing

training


Session 4

Lamaze training:

focal point,

progressive muscle

relaxation, and

patterned breathing

training

Lamaze

training: focal

point,

progressive

muscle

relaxation, and

patterned

breathing

training

Lamaze training:

focal point,

progressive muscle

relaxation, and

patterned breathing

training


Session 5

Algometer procedure; receive instructions to use this intervention in pain management (focal point, progressive muscle relaxation, and patterned breathing)

Algometer procedure; receive instructions to use this intervention in pain management (focal point, progressive muscle relaxation, and patterned breathing)

Algometer procedure; do not receive instructions to use this intervention in pain management

Algometer procedure; receive instructions to use acceptance for pain mangament

23

Table 2

Pre and Post Pain Management Duration by Group

Information Long Lamaze Brief Lamaze Acceptance Control

Mean time in

pain task 1 117.05 87.16 69.20 68.75

Mean time in

pain task 2 239.00 132.21 163.00 73.50

Measurement of time in minutes

24

Table 3

Descriptive Statistics for Mean Practice Time (in minutes) by Group

Group Mean Practice Time SD Range Median

Long Lamaze 111.08 92.25 299 97

Brief Lamaze 99.21 161.36 605 32.5

Acceptance 111.28 70.91 230 102

Control 173.84 116.14 359 155

25

Figure Captions

Figure 1. Mean Pain Management Ability (duration in post pain task) by Group

26

Figure 1

27

Appendix 1

Demographics Form:

Date:_______________________ Time: ________________________

Participant number:____________________________________________________

Participant name: _____________________________________________________

Date of Birth: _____________________________ Age: __________________

Ethnicity: (circle)

1. Caucasian 2. African-American 3. Hispanic

4. Asian 5. Native American

6. Other: _____________________________________________________

Handedness: (circle)

1. Right Handed 2. Left Handed 3. Ambidextrous (i.e. use

both hands

equally well)

Hand preference if ambidextrous: (circle)

1. Right Hand 2. Left Hand 3. Not Applicable

Rank in school: (circle)

1. Freshman 2. Sophomore 3. Junior 4. Senior

About how many hours of sleep did you get last night? _________________________

About how many hours of sleep do you usually get a night? _____________________

How many caffeinated beverages have you had today?_________________________

How many caffeinated beverages do you normally have by this time? _______________

What was the day of your last period? Day:________________________________

- Or weeks into cycle _______________________

28

Do you currently have chronic pain (pain experienced over a long period of time)?

__________________________________________________________________

- If yes,

what?_______________________________________________________

If you do not have chronic pain now, have you ever experienced such pain?

________________________________________________________________

- If yes, what/how?

_______________________________________________________

_______________________________________________________________

- When?_________________________________________

Do you currently have acute pain (sudden onset of pain that lasts a short period of time)?

__________________________________________________________________

- If yes, what/

how?_______________________________________________________

_______________________________________________________________

If you are not currently experiencing acute pain, have you ever experienced acute pain

(frequency)?

- If yes, what/how?

________________________________________________________

______________________________________________________________

29

Appendix 2

Pain Rating Scale

0 1 2 3 4 5

(0 = no pain) (5 = most possible pain)

30

Appendix 3

Anxiety Rating Scale

0 1 2 3 4 5

(0 = no anxiety) (5 = most possible anxiety)

31

Appendix 4

Long Lamaze Group Protocol

Session One (approximately 55 minutes)

- Algometer procedure

Focal Point:- “For our next session on __________ at ______, please bring in an object

that you can use as a focal point. A focal point is an object that you deliberately direct

your attention toward. This type of concentration helps you center your mind, in order to

better relax and reduce stress. Strong focal points are objects that have some kind of

meaning or personal relevance for you. Some examples are: religious articles (crosses,

rosaries, etc.), pictures of loved ones or a pet, or a picture of your favorite place.”

Progressive relaxation: Have them tense and then relax the scalp, face, neck, shoulders

and arms and hands, chest stomach & back, upper legs, lower legs and feet. Have them

imagine a pulse of relaxation entering these regions when they relax.

Assignment:

- “Between now and our next meeting on ____________ at _________, I would like you

to do some simple practicing at home. Each day, spend 10 minutes practicing your

concentrating on your focal point and doing the relaxation exercises we worked on. The

more you practice, the easier it will be for you to reach that state of relaxation when you

are under stress.” Discuss specific times when each of them is going to do the practice.

Have them E-mail you every day on their efforts. A simple sentence on their part will do.

End day one Long Lamaze

Session 2 Protocol

Note: In this Lamaze condition we are telling them that they are learning pain

management techniques where we will be putting the different skills together to learn

how to better combat pain.

Long Lamaze Protocol

Session Two

How many days did you practice? (Put these data in their file.)

How long per session? (Put these data in their file.)

Focal Point

32

- “Today you should have brought an object in to use as a focal point. If for some reason

you did not bring something with you today, please think of what you will be using and

draw a rendition of it for use now. To get you used to using your focal point, practice by

each concentrating on your focal point for 30 seconds.”

- Time 30 seconds, while subjects direct their attention to their focal points.

Repeat at 60 sec.

Repeat at 90 sec.

Repeat at 90 sec.

Breathing

- Pass out Breathing Patterns Handout

- “In addition to using a focal point, you can also learn to manage pain and stress by

using certain breathing techniques. One way in which to do this is to follow certain

breathing patterns, which help with your concentration. Remember to always begin and

end each session of breathing with a deep, slow cleansing breath. Also remember to

always breathe in between each syllable of the pattern (ex: „Ha‟ „breath‟ „Hoo‟). You

may say „He‟ instead of „Ha‟ if you prefer.”

- Go through the first two patterns with the subjects. Make sure to explain the

pattern, show them what it is like, and allow them at least a few minutes to practice

each pattern. Make sure that they are doing it correctly, and correct them if

necessary.

- “The first pattern that we will practice is the „Slow Deep‟ pattern. Begin by breathing in

through your nose, and our through your mouth. Keep the breath slow, deep, and easy.

Repeat this pattern, making sure to keep a constant rate of inhalation and exhalation.”

(Practice 3 times)

- “The second pattern is a „Shallow‟ breathing pattern. This is similar to how dogs

breathe when they pant. The pattern goes „Ha-Ha-Ha-Ha-Ha-Ha‟. Keep the breaths even

and shallow. Be careful not to breathe too quickly. Between each „Ha‟ remember to

inhale. Repeat this pattern, keeping a slow, steady rhythm.” (Practice 3 times)

- “The third pattern is „Shallow with a Puff.‟ This pattern resembles the „Choo-Choo‟

noise of a train. For example, the breaths should go „Ha-Hoo-Ha-Hoo-Ha-Hoo.‟

Remember to breathe in between each syllable. Keep the rhythm steady and slow. Repeat

this pattern, concentrating on the rhythm of your breathing.” (Practice 3 times)

33

- “The fourth pattern is „Pyramid Breathing.‟ This pattern begins with a „Ha-Hoo‟, then

goes „Ha-Ha-Hoo‟, then increases to „Ha-Ha-Ha-Hoo, and peaks at „Ha-Ha-Ha-Ha-Hoo.‟

Then the pattern declines, „Ha-Ha-Ha-Hoo‟, „Ha-Ha-Hoo‟, „Ha-Hoo.‟ This completes

one pyramid cycle. Repeat the cycle, concentrating on the number of „Ha‟s‟ so that you

keep the structure of the pyramid even.” (Practice 3 times)

- “The fifth pattern of breathing is a modification of the „Pyramid Breathing‟, for use

when you have a partner present. Your partner would instruct you on how many „Ha-„s‟

to do with your breathing pattern. Your partner would use a random pattern, such as „Ha-

Ha-Ha-Ha-Hoo‟, „Ha-Hoo‟, „Ha-Ha-Hoo‟, „Ha-Hoo‟, „Ha-Ha-Ha-Hoo‟, „Ha-Hoo‟.

Varying the pattern ensures that you will have to concentrate to do the correct number of

breaths.”

(Practice 3 times)

Relaxation

- “The next technique that we will do to help you manage your stress is a simple

relaxation method called Progressive Muscle Relaxation. This method is meant to help

you reach a state of complete relaxation. Practicing the following exercise will enable

you to know what it feels like to be fully relaxed. Then when you feel stressed, you can

recall that feeling of relaxation.



imagine a pulse of relaxation entering these regions when they relax. Then have them try

to imagine this pulse passing down their bodies three times. Give them 30 seconds to get

it, 15 more to “enjoy it” and then tell them to come alert to stop. Have them share

experiences with it for about 60 seconds, and then do it again and again for the three

times.

Coordinate the breathing, relaxation, and focal point exercises and practice five

times.

Note: in each coordinated practice session, have them do the first breathing exercise for

60 sec., followed by the second breathing exercise for 60 sec. etc. until all breathing types

are achieved.

Assignment:



breathing patterns, while concentrating on your focal point. Also spend 10-15 minutes

34

practicing your muscle relaxation technique. The more you practice, the easier it will be

for you to reach that state of relaxation when you are under pain.”

End day two Long Lamaze

Session 3 Protocol

Note: In the Lamaze condition we are telling them that they are learning pain




Session Three

How many days did you practice? Put these data in their file.)

Discussion on the importance of Lamaze (motivation for participation):

- I want to make sure that we discuss the importance of your participation and

active effort in this study.

- In this study we are trying to see how Lamaze can help individuals experiencing

other forms of pain (other than pregnancy pain).

- We are trying to see how individuals who learn this technique perform under a

pain task similar to the one you have already experienced.

- Pain is one of the leading concerns in health care treatment today. There are

serious costs to individuals, health care systems, and general society.

- Medication-based pain treatment is pricy, and many individuals have limited

access to such treatments and there are many problems with adherence to pain

treatment (people not following prescriptions and dosages).

- We need to help people who are in pain…we are just trying to help them find

alternatives to medication treatment.

- Your help in this study will guide us in answering questions about how alternative

non-medication treatments can help pain patients.

- Lamaze combines a number of alternative techniques that have been proven very

successful in treating pain (for example, breathing relaxation, distraction, and

relaxation). Lamaze is unique in that it combines all of these techniques together,

which may show to be more successful than other techniques individually.

- Again, this study is important, and people in pain can be helped by its results.

During session:

- Walk around room giving direct feedback on performance

- At the end of the session have each participant model the technique to

demonstrate their mastery of the technique.

o If mastery is not determined, tell participant that they will be asked at the

beginning of the following session to demonstrate mastery (they should

practice if needed)

35

How long per session? Put these data in their file.)

Focal Point

- “Today you should have brought an object in to use as a focal point. Remember: the

focal point should be an image or object that represents something of value and

importance to you and bring you peace of mind during painful episodes. For example, if

you bring a crucifix, star of David, picture of some significant other or place that eases

pain and suffering, then bring that. This focal point will be a tool later for pain

management and will allow you to focus on this focal point rather than pain you may

experience. If for some reason you did not bring something with you today, please think

of what you will be using and draw a rendition of it for use now. To get you used to using

your focal point, practice by each concentrating on your focal point for 30 seconds.”


Repeat at 60 sec.

Repeat at 90 sec.

Repeat at 90 sec.

Breathing










necessary.


through your nose, and out through your mouth. Keep the breath slow, deep, and easy.


(Practice 3 times)





36




this pattern, concentrating on the rhythm of your breathing.”





keep the structure of the pyramid even.”






breaths.”

Relaxation

- “The next technique that we will do to help you manage your stress and future pain

experiences is a simple relaxation method called Progressive Muscle Relaxation. This

method is meant to help you reach a state of complete relaxation. Practicing the following

exercise will enable you to know what it feels like to be fully relaxed. Then when you

feel stressed or in pain you can create that feeling of relaxation.

Progressive relaxation: Have them tense and then relax the forehead (wrinkle their

forehead), face (scrunch their face tightly), neck (tense and strain their neck), shoulders

(scrunch up shoulders) and arms (tighten their arms as if doing a bicep curl) and hands

(make tight fists), chest stomach (tighten chest while sucking in stomach) & back (tense

back while arching it), upper legs (squeeze and tense up thigh muscles), lower legs

(straighten legs while pulling toes up toward body) and feet (curl feet up tightly). As

they are doing each area verbally suggest that they note how their body feels differently

when tense versus relaxed. Have them imagine a pulse of relaxation entering these

regions when they relax. Then have them try to imagine this pulse passing down their

bodies three times. Give them 30 seconds to get it, 15 more to “enjoy it” and then tell

them to come alert to stop. Have them share experiences with it for about 60 seconds,

and then do it again and again for the three times.


times.

37



are achieved.

Have them practice for at least 45 min.

Assignment:






(Remind them that they will need to demonstrate mastery of the techniques)

End of day three Long Lamaze

Session 4 Protocol

Note: In the Lamaze condition we are telling them that they are learning pain




Session Four



Today is the last day of your training. You will have to work hard today and practice this

technique because we will be doing the Algometer again next week, and doing this

technique with the Algometer should allow you to block pain you might experience.

Focal Point







38





Repeat at 60 sec.

Repeat at 90 sec.

Repeat at 90 sec.

Breathing







“The first pattern that we will practice is the „Slow Deep‟ pattern. Begin by breathing in



(Practice 3 times)

















39



breaths.”

Relaxation



















times.



are achieved.


Assignment:






40

Today was the last day of your training. You will have to work hard today and practice

this technique because we will be doing the Algometer again next week, and doing this


End day four Long Lamaze

Session 5 Protocol

Day 5: Final day of testing. Note: this is where we first put the empty block on for 30

sec., then place heavy weight on until 5 min elapses, and then place the additional next

lighter weight on for 2 min, and then the next one on for 3 min. if necessary.

Use the scale below and rate each participant every 15 sec. just as you did

with the pain ratings you made earlier.

Goodness of Lamaze rating scale:

Poor Somewhat Poor Average Somewhat good Good

1 2 3 4 5

41

Appendix 5

Brief Lamaze Group Protocol

Session One

- Algometer (approximately 45 minutes)

Ask them what they are majoring in. If some do not know, have them list their 3

most probable choices. Talk about each and give the homework assignment of looking

up all the jobs they can get with this major, and which ones they might find most

enjoyable. Tell them to look up on the computer options for the majors and what each

type of job would entail. - “Between now and our next meeting on ____________ at

_________, I would like you to do some simple practicing at home. Each day, spend 10

minutes practicing your concentrating on your major. The more you concentrate, the

easier it will be for you to reach a state of relaxation when you are under stress.” Discuss

specific times when each of them is going to do the practice. Have them E-mail you

every day on their efforts. A simple sentence on their part will do.

End day one Short Lamaze

Session 2 Protocol

Note: The whole technique will be taught to the One day Lamaze on week 4 only.

Remember, they are getting advising only.

Short Lamaze Protocol (One day of Lamaze on the fourth day.)

Day 2


most probable choices. Have each present what jobs they found on their searches. Ask

them what ones are most enjoyable.

1. Have the group then discuss the strengths and weaknesses of each job type

each participant found.

2. Have each talk of a past job, and what they liked versus did not like about it.

(have a general conversation about each job. Goal=take up time.

3. If time is left over, then have them do the following:

4. Have each share images of what each would be doing in the jobs selected,

with difficult and easy parts.

42

5. Then have them talk about the importance of co-workers and how this can

either help or hinder job enjoyment. (Share stories of good versus bad

coworkers)

6. Tell them to look up on the computer options for the majors and what each

type of job would entail. - “Between now and our next meeting on

____________ at _________, I would like you to do some simple practicing

at home. Each day, spend 10 minutes practicing your concentrating on your

major. The more you concentrate, the easier it will be for you to reach a state

of relaxation when you are under stress.” Discuss specific times when each of

them is going to do the practice. Have them E-mail you every day on their

efforts. A simple sentence on their part will do.

End day two Short Lamaze

Session 3 Protocol

Note: The whole technique will be taught to the One day Lamaze on week 4 only.

Remember, they are getting advising only.


Day Three


most probable choices. Have each present what jobs they found on their searches. Ask

them what ones are most enjoyable.

7. Have the group then discuss the strengths and weaknesses of each job type

each participant found.

8. Have each talk of a past job experiences, and what they liked versus did not

like about it. (have a general conversation about each job. Goal=take up

time.

9. If time is left over, then have them do the following:

10. Have each share images of what each would be doing in the jobs selected,

with difficult and easy parts.

11. Then have them talk about the importance of co-workers and how this can

either help or hinder job enjoyment. (Share stories of good versus bad

coworkers)

12. Have them practice for at least 45 min

13. Tell them to look up on the computer options for the majors and what each

type of job would entail. - “Between now and our next meeting on

____________ at _________, I would like you to do some simple practicing

at home. Each day, spend 10 minutes practicing your concentrating on your

major. The more you concentrate, the easier it will be for you to reach a state

of relaxation when you are under stress.” Discuss specific times when each of

them is going to do the practice. Have them E-mail you every day on their


End day three Short Lamaze

43

Session 4 Protocol





technique because we will be doing the Algometer again next week, and doing this


Session 4

Focal Point











Repeat at 60 sec.

Repeat at 90 sec.

Repeat at 90 sec.

Breathing









44


necessary.




(Practice 3 times)



















breaths.”

Relaxation










45










times.



are achieved.


Assignment:






Today was the last day of your training. You will have to work hard today and practice

this week because we will be doing the Algometer again next week, and using this

technique should allow you to block pain you might experience.

End day four Short Lamaze

Session 5 Protocol




Use the scales below and rate each participant every 15 sec. just as you did with

the pain ratings you made earlier.

Goodness of Lamaze rating scale


1 2 3 4 5

46

Appendix 6

Control Group Protocol

Session One

- Algometer procedure

Focal Point:

- “For our next session on __________ at ______, please bring in an object that you can

use as a focal point. A focal point is an object that you deliberately direct your attention

toward. This type of concentration helps you center your mind, in order to better relax

and reduce stress. Strong focal points are objects that have some kind of meaning or

personal relevance for you. Some examples are: religious articles (crosses, rosaries, etc.),

pictures of loved ones or a pet, or a picture of your favorite place.”

Progressive relaxation: Have them tense and then relax the scalp, face, neck,

shoulders and arms and hands, chest stomach & back, upper legs, lower legs and feet.

Have them imagine a pulse of relaxation entering these regions when they relax.

Assignment:



concentrating on your focal point and doing the relaxation exercises we worked on. The

more you practice, the easier it will be for you to reach that state of relaxation when you

are under stress.” Discuss specific times when each of them is going to do the practice.

Have them E-mail you every day on their efforts. A simple sentence on their part will do.

End day one Rescorla Control

Session 2 Protocol

Rescorla Control - no mention of pain will be made. They are learning this to find

out different techniques to cope with stress.

Session Two

How many days did you practice? Put these data in their file.

47

How long per session? Put these data in their file.

Focal Point

- “Today you should have brought an object in to use as a focal point. If for some reason

you did not bring something with you today, please think of what you will be using and

draw a rendition of it for use now. To get you used to using your focal point, practice by

each concentrating on your focal point for 30 seconds.”


Repeat at 60 sec.

Repeat at 90 sec.

Repeat at 90 sec.

Breathing

- Pass out Breathing Patterns Handout

- “In addition to using a focal point, you can also learn to manage and stress by using

certain breathing techniques. One way in which to do this is to follow certain breathing

patterns, which help with your concentration. Remember to always begin and end each

session of breathing with a deep, slow cleansing breath. Also remember to always breathe

in between each syllable of the pattern (ex: „Ha‟ „breath‟ „Hoo‟). You may say „He‟

instead of „Ha‟ if you prefer.”




necessary.







inhale. Repeat this pattern, keeping a slow, steady rhythm.”



48













breaths.”

Relaxation





recall that feeling of relaxation.



imagine a pulse of relaxation entering these regions when they relax. Then have them try

to imagine this pulse passing down their bodies three times. Give them 30 seconds to get

it, 15 more to “enjoy it” and then tell them to come alert to stop. Have them share

experiences with it for about 60 seconds, and then do it again and again for the three

times.

Coordinate the breathing, relaxation, and focal point exercises and practice five times.



are achieved.

Assignment:



49



for you to reach that state of relaxation when you are under stress.”

End day two Rescorla Control

Session 3 Protocol

Note: In our Rescorla Control we say that we are teaching them” stress management”



Session Three



Focal Point





your mind, then bring that. This focal point will be a tool later for relaxation

management and will allow you to focus on this focal point rather than stress you may





Repeat at 60 sec.

Repeat at 90 sec.

Repeat at 90 sec.

Breathing




50







necessary.






















breaths.”

Relaxation





create that feeling of relaxation.

51














times.



are achieved.

Have them practice for at least 45 min

Assignment:






End day three Rescorla Control

Session 4 Protocol

Note: In our Rescorla Control we say that we are teaching them” stress management”



Session Four


52



technique because we will be doing the Algometer again next week, and practicing these

general techniques now should help you block pain you might experience in the future.

Focal Point





your mind, then bring that. This focal point will be a tool later for relaxation

management and will allow you to focus on this focal point rather than stress you may





Repeat at 60 sec.

Repeat at 90 sec.

Repeat at 90 sec.

Breathing










necessary.




53



















breaths.”

Relaxation





create that feeling of relaxation.













54


times.



are achieved.


Assignment:






Today was the last day of your training. Please practice hard during the week because we

will be doing the Algometer again next week, and practicing these general techniques

now should help you block pain you might experience in the future.

End day four Rescorla Control

Session 5 Protocol




Use the scale below and rate each participant every 15 sec. just as you did

with the pain ratings you made earlier.

Goodness of Lamaze rating scale:


1 2 3 4 5

Rescorla control

“We are going to do the Algometer test again and then go back to the room and resume

our activities like we did on the first day. When you feel pain like you felt the first day,

hit the stop sign and I will take the weights off. Do you have any questions?” (Note: If

they ask if they should do what they learned, you should tell them “no” and note that they

asked. If they begin doing Lamaze when you first put the un-weighted block on their

finger or any time thereafter, ask them to stop and note this on your notes.”

55

Appendix 7

Acceptance Group Protocol

Session One

- Algometer (approximately 45 minutes)

Introduction to Acceptance and Commitment Therapy (ACT) for pain management:

Read the following to the participants.

Acceptance and Commitment Therapy (also known as ACT), is an intervention

that is part of a new wave of therapies. ACT offers an alternative way to cope with

stressors, symptoms, and other negative symptoms in a manner that focuses on accepting

such difficulties with focus on life goals and values, rather than trying to control them.

By accepting distress and problems, individuals can redirect their attention, energy, and

focus from problems they cannot control, and target issues that are important for their

well-being and life satisfaction (such as goals and values). By focusing on one's goals

and values, individuals find themselves feeling more goal-directed, motivated, and

optimistic despite the distress that they may presently be experiencing.

ACT strives to do three things:

1) help individuals to accept themselves, others, and experiences with compassion

2) choose valued directions in life

3) commit to actions that promote their advancement toward that direction.

(Hayes, Strosahl, & Wilson, 1999)

Discuss the concept of acceptance and apply it to general daily experiences.

“Between now and our next meeting on ____________ at _________, I would like you

to do some simple practicing at home. Each day, spend 10 minutes practicing acceptance

for any pains you had throughout the day. The more you concentrate, the easier it will be

for you to reach a state of relaxation when you are under stress.” Discuss specific times

when each of them is going to do the practice. Have them E-mail you every day on their


End day one Acceptance

Session 2:


56

Read the following to the participants. Note: This is the material you read a week ago.

Read it again, and then read the second part of this as well.)


that is part of the new wave of therapies. ACT offers an alternative way to cope with



By accepting distress and problems, individuals can redirect their attention, energy, and

focus from problems they cannot control, and target issues that are important for their



optimistic despite the distress that they may presently be experiencing.





(Hayes, Strosahl, & Wilson, 1999).

(New material to read to participants)

Additional information for later sessions/explanations:

ACCEPTANCE OF PAIN AND DISABILITY

Richard W. Hanson, Ph.D. (2000)

“While it is important to use problem-solving approaches whenever possible, we must

also realize that there are many adverse situations and events in life that offer few if any

opportunities for problem solving. Pain, suffering, disease, old age, and death are

inevitable parts of human existence. No matter who we are, how healthy or physically fit

we are, or how much money and power we have, we will all eventually die. Nothing can

really prevent the physical aging process, erase unpleasant events that have already

occurred, change who our parents and children are, alter our genetic make-up, or end

reality of pain. For many, chronic pain and associated physical limitations are not so

much problems to be solved (i.e., made to go away), but rather they are realities to be

accepted. In fact, whenever you are faced with an unsolvable problem or an adverse

situation that will never go away, you are forced to wrestle with the issue of acceptance.

57

Acceptance of pain and related problems is a significant stumbling block for many. This

may be due to confusion and misunderstanding regarding the meaning of acceptance.

First of all, I am not suggesting that you must accept needless suffering. In particular, I

see no need to accept having to live with constant severe pain. Many pain medications

are available which can lower your pain to a more tolerable level. However, it may not

be reasonable to expect that these drugs will make you totally pain free. Therefore,

acceptance does mean having to accept living with a certain amount of pain. Second,

acceptance does not mean that one has to give up all hope and feel defeated. Rather, one

can maintain hope for a better future while accepting today's unpleasant realities. Third,

acceptance does not mean that you have to accept someone else's version of your

condition. For example, some pain patients have been given bleak prognoses by their

doctor and subsequently proven the doctor wrong. Finally, acceptance has nothing to do

with apathy and not caring. You don't have to like the situation you are in. Certainly you

would prefer that things were different. Healthy acceptance means recognizing the futility

of struggling against the unpleasant realities that are beyond your control. It means

recognizing that no amount of agonizing over and bemoaning your fate is going to make

things any better. True acceptance means coming to terms mentally and emotionally with

your unpleasant reality. It means coming to peace with the adverse reality that you are

currently facing. You can say to yourself, "I don't like having this chronic pain condition,

but I'm going to do everything I can to make my life as best as I can despite the pain."

Healthy and peaceful acceptance of unpleasant realities like pain and disability is one of

the most important things that you can do mentally to reduce stress and maintain peace of

mind. Remember that acceptance is not a one-time decision. Rather, it is an ongoing

process which must be re-experienced every day.

Acceptance as a Way of Coping with Pain

The tendency to fight and resist pain at a physical and mental level may seem like an

automatic reflex process. Unfortunately, the chronically elevated physical and mental

tension that results from this ongoing struggle usually takes its toll on your body and

mental functioning. Muscles and joints become stiff and rigid. Mentally and emotionally

you become tense and irritable, or you simply become exhausted by the continual battle

against the pain.

Acceptance as a coping method means learning to tune into your body and move your

body while relaxing at the same time. Techniques to accomplish this involve focused

breathing awareness and passive body scan. With practice you can learn to breathe into

and through painful areas of your body, maintaining awareness of the relaxing breath

while allowing pain sensations to ebb and flow in a non-judgmental manner. Rather than

labeling the sensations as bad and fighting against them, you simple note them, accept

58

them, and return to your breathing meditation. Likewise, you can learn to gradually and

gently stretch your muscles and joints while maintaining the breathing awareness. Rather

than trying to move or stretch while simultaneously tensing and contracting your muscles

when you experience discomfort, you learn to remain mindful of the relaxing breath. It

becomes so much easier to stretch and move your body when you are relaxed and not

fighting against yourself.”

Here they can discuss how this might have worked in the past when they had suffered a

painful episode. Try to get each participant to share an incident when they had pain and

how this might have helped.

“Between now and our next meeting on ____________ at _________, I would like you to

do some simple practicing at home. Each day, spend 10 minutes practicing acceptance for

any pains you had throughout the day. The more you concentrate, the easier it will be for

you to reach a state of relaxation when you are under stress.” Discuss specific times

when each of them is going to do the practice. Have them E-mail you every day on their


End day two Acceptance

Session 3:

Acceptance Group








By accepting distress, problems, and pain, individuals can redirect their attention, energy,

and focus from problems they cannot control, and target issues that are important for their



optimistic despite the distress and pain that they may presently be experiencing.




59




































60











against the pain.





















when each of them is going to do the practice (Suggestion: perhaps bedtime is a great

time to reflect on the day for ten or so minutes and practice acceptance). Have them E-

mail you every day on their efforts. A simple sentence on their part will do.

End day three Acceptance

61

Session 4:

Acceptance Group




technique because we will be doing the Algometer again next week, and using this

technique should allow you to block pain you might experience.








By accepting distress, problems, and pain, individuals can redirect their attention, energy,

and focus from problems they cannot control, and target issues that are important for their



optimistic despite the distress and pain that they may presently be experiencing.










62






































63



against the pain.





















when each of them is going to do the practice (Suggestion: perhaps bedtime is a great

time to reflect on the day for ten or so minutes and practice acceptance). Have them E-

mail you every day on their efforts. A simple sentence on their part will do.

Remember: Today was the last day of your training. You will have to work hard this

week and practice this technique because we will be doing the Algometer again next

week, and using this technique should allow you to block any pain you might experience.

End day four Acceptance

Session 5:




64

Use the scale below and rate each participant every 15 sec. just as you did with the pain

ratings you made earlier.

Goodness of Acceptance rating scale:


1 2 3 4 5

Acceptance:

“When I place the wooden block on your finger, I want you to do the techniques we have

been practicing. First, place your mind in the mode you practiced and try to use what you

now know about acceptance. Try to do the techniques as long as you can, but when you

feel pain that it too painful to stand, hit the stop sign and I will take the weights off. Do

you have any questions?”

65

66

References

Ballantyne, J. C. (2007). Opiod analgesia: Perspectives on right use and utility. Pain

Physician, 10, 479-491.

Cheatle, M. D., & Gallagher, R. M. (2006). Chronic pain and comorbid mood and

substance use disorders: A biopsychosocial treatment approach, Current

Psychiatry Reports, 8, 371-376.

Dahlquist, L. D., McKenna, K. D., Jones, K. K., Dillinger, L., Weiss, K. E., & Ackerman,

C. S. (2007). Active and passive distraction using a head-mounted display helmet:

Effects on cold pressor pain in children. Health Psychology, 26, 794-801.

De Jong, A. E. & Gamel, C. (2006). Use of a simple relaxation technique in burn care:

literature review. Journal of Advanced Nursing, 54, 710-721.

Dogan, S. K., Tur, B. S., Kurtais, Y., & Atay, M. (2008). Comparison of three different

approaches in the treatment of chronic low back pain. Clinical Rheumatology, 27,

873-881.

Field, T. (2008). Pregnancy and labor alternative therapy research. Alternative Therapies

in Health and Medicine, 14, 28-34.

Gourlay, D. L., Heit, H. A., & Almahrezi, A. (2005). Universal precautions in pain

medicine: A rational approach to the treatment of chronic pain. Pain Med, 6, 107-

112.

Hanson, R. W. (2000). Acceptance of pain and disability. Retrieved from

http://www.arachnoiditis.info/website_captures/chronicpainhandbook/Mental%20

Health-%20VA%20Long%20Beach%20Healthcare%20System.htm

Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and commitment therapy:

An experiential approach to behavior change. New York: Guilford Press.

Hojsted, J., & Sjogren, P. (2007). Addiction to opiods in chronic pain patients: A

literature review. European Journal of Pain. 11, 490-518.

Hurwitz, E. L., Goldstein, M. S., Morgenstern, H., & Chiang, L. (2006). The impact of

psychosocial factors on neck pain and disability outcomes among primary care

patients. Results from the UCLA Neck Pain Study. Disability and Rehabilitation,

28, 1319-1329.

Karmel, M. (1959). Thank you, Dr Lamaze. New York: Harper & Row.

http://www.arachnoiditis.info/website_captures/chronicpainhandbook/Mental%20Health-%20VA%20Long%20Beach%20Healthcare%20System.htm

http://www.arachnoiditis.info/website_captures/chronicpainhandbook/Mental%20Health-%20VA%20Long%20Beach%20Healthcare%20System.htm

67

Kaulagekar, A., & Radkar, A. (2007). Social status makes a difference: tuberculosis

scenario during National Family Health Survey – 2. The Indian Journal of

Tuberculosis, 53, 17-23.

Klusman, L. E. (1975). Reduction of pain in childbirth by the alleviation of anxiety

during pregnancy. Journal of Consulting and Clinical Psychology, 43, 162-165.

Kwekkeboom, K. L., & Gretarsdottir, E. (2006). Systematic review of relaxation

interventions for pain. Journal of Nursing Scholarship, 38, 269-277.

Lamaze, F. (1970). Painless Childbirth Psychoprophylactic Method. Chicago: Regnery

Company.

Leventhal, A. E., Leventhal, H., Shachan, S., & Easterling, D. V. (1989). Active coping

reduces reports of pain from childbirth. Journal of Consulting and Clinical

Psychology, 57, 365-371.

Loeser, J. D. (1999). Economic implications of pain management. ACTA

Anaesthesiologica Scandinavica, 43, 957-959.

McCaul, K. D., & Malott, J. M. (1984). Distraction and coping with pain. Psychological

Bulletin, 95, 516-533.

Nawar, E. W., Niska, R. W., & Xu, J. (2007). National Hospital Ambulatory Medical

Care Survey, 2005 Emergency Department Summary. Advance Data from Vital

and Health Statistics, 386, 1-32.

Rainwater, A. J., & McNeil, D. W. (1991). Reinventing the Algometer: Synopsis of the

literature and presentation of a reliable, inexpensive model. Behavior Research

Methods, Instruments, & Computers, 23, 486-492.

Rescorla, R. A. (1967). Pavlovian conditioning and its proper control procedures.

Psychological Review, 74, 71-80.

Seers, K., Watt-Watson, J., & Bucknall, T. (2006). Challenges of pain management for

the 21st century. Journal of Advanced Nursing, 55, 4-6.

Seligman, M. E. P., & Hager, J. (1972). Biological Boundaries of Conditioning. New

York: Appleton-Century-Crofts Inc.

Strote, M. E. (2007). Cutting Class. Fit Pregnancy, 14, 54-56.

Turk, D. C., & Burwinkle, T. M. (2005). Clinical outcomes, cost-effectiveness, and the

role of psychology in treatments for chronic pain sufferers. Professional

Psychology: Research and Practice, 36, 602-610.

68

Turk, D. C., & Feldman, C. S. (1992). Noninvasive approaches to pain control in terminal

illness: the contribution of psychological variables. The Hospice Journal, 8, 1-23.

Turk, D. C., Swanson, K. S., & Tunks, E. R. (2008). Psychological approaches in the

treatment of chronic pain patients – When pills, scalpels, and needles are not

enough, Canadian Journal of Psychiatry, 53, 213-223.

Vowles, K. E. & McCracken, L. M. (2008). Acceptance and values-based action in

chronic pain: A study of treatment effectiveness and process. Journal of

Consulting and Clinical Psychology, 76, 387-407.

Wideman, M. V., & Singer, J. E. (1984). The role of psychological mechanisms in

preparation for childbirth. American Psychologist, 39, 1357-1371.

Wiederhold, M. D., & Wiederhold, B. K. (2007). Virtual reality and interactive

simulation for pain distraction. Pain Medicine, 8, S182-S188.

69

Emily M. Selby-Nelson, M.A.

Curriculum Vitae

________________________________________________________________________

PERSONAL INFORMATION

Permanent Address: E-mail:

1979 Parkwood Road [email protected]

Charleston, WV 25314

__________________________________________________________________

EDUCATION

Marshall University

Doctor of Psychology (Psy.D.), Clinical Psychology

Expected Degree Date: May 2011

Marshall University

Master‟s Degree in Psychology (M.A.)

West Virginia University

Bachelor of Arts in Psychology, Magna Cum Laude

__________________________________________________________________

CLINICAL EXPERIENCE

WVU Department of Behavioral Medicine & Psychiatry, July 2010 – July 2011

Outpatient Psychiatry Rotation, Therapist

Outpatient individual cognitive-behavioral therapy with individuals ranging from

age 4 to 76 with a variety of mental health diagnoses, family therapy using

Parent-Child Interaction Therapy, and participation in a rural mental health

rotation with Dr. Fields and treated patients in the context of a family practice

clinic through Cabin Creek Health Systems.

Supervisors: John C. Linton, Ph.D., Laura Wilhelm, Ph.D., Holly C. Cloonan,

Ph.D., Susan Walker-Matthews, Ph.D., Scott Fields, Ph.D.

Neuropsychological Assessment Laboratory

Psychodiagnostic and neuropsychological assessments; completion of

comprehensive assessments including IQ testing, assessment of developmental

disabilities, neuropsychological assessment to determine ADHD, and personality

testing; report writing, development of recommendations for patients, and

collaborating with families and patients to provide feedback and guidance.

Supervisor: Raymond K. DiPino, Ph.D

CAMC Cardiac Rehabilitation Center

Presentation of psychoeucational sessions to cardiac rehab patients including

topics such as relaxation, stress management, coping with anxiety and depression,

time management, anger management; therapy with cardiac rehab patients with

70

depression, anxiety, stress, problems adjusting to lifestyle changes following

surgery, aggression and anger, and relationship problems; collaboration with team

of professionals providing integrative care to cardiac rehab patients.

Supervisor: Melisa Chelf-Sirbu, Ph.D.

CAMC General Hospital: Adult Psychiatric Inpatient Unit

Co-facilitation in group therapy (both CBT and psychodynamic); individual

therapy with patients; consultation with residents, attending physicians, and staff

regarding the treatment progress and medical management of patients;

participation in a team consisting of medical students, a psychiatric resident,

nurses, and an attending psychiatrist in the management of individual patients;

crisis intervention experience while taking 24-hour call in the Emergency

Department with psychiatric resident.

Supervisor: Laura Wilhelm, Ph.D.

Woodland Centers (Behavioral Health Services); Galipolis, OH; August 2009 – May

2010

Psychological Trainee, Rural Practicum

Participation in individual supervision, individual psychotherapy, family therapy,

psychodiagnostic assessment (i.e. personality, bariatric assessment, IQ, executive

functioning, symptom assessment, etc.), clinical writing (case notes, reports, etc.),

case review, crisis intervention, consultation, behavioral health intervention (e.g.

adjustment to medical treatment), attendance to 1.5 hours of group supervision

weekly and 2 hours of individual supervision weekly.

Supervisor: Wes Crum, Ph.D.

River Park Hospital; Huntington, WV; January 2009 – August 2009

Psychological Trainee, Community Practicum

Participation in treatment team meetings, attendance to grand rounds, individual

supervision, group supervision, completion of psychosocial assessments,

individual psychotherapy, group psychotherapy, psychodiagnostic assessment,

clinical writing, observation and interaction with patients on unit, case review,

consultation, chemical dependence and substance abuse treatment experience, and

attendance to 1.5 hours of group supervision weekly and 1 to 2 hours of

individual supervision weekly.

Supervisor: Donna Midkiff, Ph.D.

Mildred-Mitchell Bateman Hospital; Huntington, WV; August 2008- January 2009

Psychological Trainee, Community Practicum

Attendance and participation in treatment team meetings, completion of initial

assessments, completion of psychological assessments, individual therapy, group

therapy, observation and interaction with patients on unit, assessment conduction,

assessment writing, clinical writing, case review, consultation, and attendance to

1.5 hours of group supervision weekly and 2 hours of individual supervision

weekly.

Supervisor: Vernon Kirk, Psy.D.

71

Marshall University, Department of Psychology

Psychological Trainee, Clinical Practicum, August 2007- August 2008

Attendance to weekly staff meetings, maintenance of case load, conducting

intake sessions, conducting psychotherapy sessions, case note completion,

cognitive conceptualization completion, clinical report writing, case relevant

research, intervention implementation, psychological skills training presentations

(stress management, anger management, relationship and social skills training,

anxiety reduction, depression reduction, sleep disturbance management,

professional development, educational development, etc.), university outreach

activities, and attendance to 1.5 hours of group supervision weekly and 1 hour of

individual supervision weekly.

Supervisor: Thomas Ellis, Psy. D., Marty Amerikaner, Ph.D., Pamela Mulder,

Ph.D.

Psychological Trainee, Advanced Doctoral Assessment Practicum, Fall, 2007-

Fall, 2008

Attendance at individual supervision meetings, completion of intake sessions

(mental status, history, and referral question), assessment administration,

assessment scoring, assessment report writing, assessment feedback, and referral

recommendation.

Supervisor: Keith Beard, Psy.D., and Marianna Linz, Ph.D.

Head Start Consultation Program, Fall, 2007 - Spring, 2008

Visitation at 3 Head Start locations, observation of classroom functioning and

child behavior, consultation in response to observed problems/concerns, and

completion of documentation of observation results.

Supervisor: Marianna Linz, Ph.D.

Integrated Assessment Practicum I and II, Fall 2006 - Spring 2007

Attendance to weekly lecture and practicum meetings, completion of mock cases

(including intake and assessment administration), assessment report writing, and

case presentation.

Supervisor: Pamela Mulder, Ph.D., and Marianna Linz, Ph.D.

ADDITIONAL CLINICAL AND PROFESSIONAL TRAINING

Cognitive Behavioral Therapy Seminar and Group Supervision

Location: WVU Department of Behavioral Medicine & Psychiatry

Duration: September 2010 – present

Duties: Participation in weekly CBT training modules, case presentation and

discussion, and video review.

Dialectical Behavior Therapy Seminar

Location: WVU Department of Behavioral Medicine & Psychiatry

Duration: January 2011 – present

Duties: Participation in weekly DBT training modules, case presentation and

discussion, and video review.

72

Clinical Workshop: Motivational Interviewing

Location: West Virginia University/ Quin Curtis Center

Date: September 2011

Clinical Workshop: Integrative Primary Care

Location: West Virginia Psychological Association, Fall Event (WV)


Clinical Workshop: Besides Alzheimer’s Disease: Vascular and Lewy Body Dimensions

Location: West Virginia Psychological Association, Fall Event (Charleston, WV)


Clinical Workshop: Psychological Assessment and Intervention in Primary Care

Location: Ohio Psychological Association Spring Event (Columbus, OH)

Date: June 2009

Clinical Workshop: Advanced and Collaborative Case Formulation and

Conceptualization

Location: The Convention for the Advancement of Behavioral and Cognitive

Therapies

(Orlando, Florida)

Date: November, 2008

Clinical Training: Suicide Prevention

Location: West Virginia Suicide Prevention Conference (Charleston, WV)

Date: June, 2008

Clinical Workshop: Acceptance and Commitment Therapy for Anxiety Disorders

Location: The Convention for the Advancement of Behavioral and Cognitive

Therapies

(Orlando, Florida)

Date: November, 2007

________________________________________________________________________

RESEARCH EXPERIENCE

Research Experience during Predoctoral Internship

Project: An examination of the role of distracters in the loss of information during

warm handoffs.

Faculty Supervisor: Dr. Elise Drake

Duties: Literature review

Duration: August 2010 - present

Doctoral Research Project/ Dissertation

Project: The application of the Lamaze Method in the treatment of acute pain: a

comparison of alternative pain management techniques

Faculty Chair: Dr. Lindberg

Duration: August 2008-present

73

Research experience through collaboration with West Virginia University’s Anxiety,

Psychophysiology, and Pain Research Laboratory

Project: Participation in research and presentation (see presentations)

Faculty Advisor: Dr. Daniel McNeil

Duration: 2006, 2007, and 2008

Duties: Continued interaction and collaboration with the research laboratory and

conduction of research projects in West Virginia area.

Senior Honors Thesis, West Virginia University Department of Psychology

Project: Oral-Facial Clefts and Psychosocial Implications

Thesis Supervisor: Dr. Daniel McNeil

Duration: May, 2005 – May 2006

Duties: Developed original research project to explore the psychological

implications of social development of individuals affected with oral-facial clefts.

Presentations to the Center for Craniofacial and Dental Genetics at University of

Pittsburgh.

Research Assistant, West Virginia University Department of Psychology; Anxiety,

Psychophysiology, and Pain Research Laboratory

Duration: August 2004 – May 2006

Supervisor: Dr. Daniel McNeil

Duties: Weekly meetings, running subjects, recording of lab meeting minutes, lab

meeting readings, Institutional Review Board ethics and HIPPA training,

presentation of studies, data entry and analysis, and collection of data with human

research participants.

Student Temp, West Virginia University School of Dentistry; Research Assistant for the

Center for Oral Health Research in Appalachia (NIDCR-funded projects).

Duration: June 2005 – February 2006

Supervisor: Dr. Richard Crout and Dr. Daniel McNeil

Duties: Attending weekly conference calls, conference minute recording, clerical

tasks (e.g. copying, filing, delivering materials), checking of data, completion of

travel, invoice, and other forms, aiding in grant writing, and training of other

employees.

PUBLISHED ABSTRACT

McNeil, D. W., Crout, R. J., Weyant, R. J., Widoe, R. K., Martins, R. K., Marazita, M.

L., Fluharty, K. K., & Selby, E. M. (2004). Toward an understanding of dental

fear in Appalachia [Abstract]. Journal of Dental Research, 84, A-2002.

PRESENTATIONS

Selby, E. M. & Lindberg, M. (2009). The application of the Lamaze Method in the

treatment of acute pain: A comparison of alternative pain management

techniques. Poster presented at the Fall Conference for the West Virginia

Psychological Association, Charleston, WV.

74

Selby, E.M., Ellis, T. E. & Mills, J. (2008). Cognitive and Behavioral Implications of

Parental Modeling of Health Behaviors. Poster presented at the 42nd

annual

meeting of the Academy for Behavioral and Cognitive Therapies, Orlando, FL.

Mills, J., Ellis, T. E., & Selby, E. M. (2008). Childhood influences and cognitive factors

associated with sexual risk behaviors among young adults. Poster presented at

the 42nd

annual meeting of the Academy for Behavioral and Cognitive Therapies,

Orlando, FL.

Martins, R. K., McNeil, D. W., Weinstein, B., & Selby, E. M. (2008). Reducing oral

health disparities among pregnant women in Appalachia. Poster presented at the

42nd

annual meeting of the Academy for Behavioral and Cognitive Therapies,

Orlando, FL.

Selby, E. M., McNeil, D. W., Weinstein, McCoy, M. E., and B. J., Marazita, M. L.

(November, 2007) Fears of negative evaluation and other social anxieties

associated with oral-facial clefts: A cross-cultural comparison. Poster presented

at the 41st Annual Convention of the Association for Behavioral and Cognitive

Therapies, Chicago, IL.

Selby, E. M., McNeil, D. W., Weinstein, McCoy, M. E., and B. J., Marazita, M. L.

(2006, November) Fears of negative evaluation and other social anxieties

associated with oral-facial clefts. Poster presented at the 40th

Annual Convention

of the Association for Behavioral and Cognitive Therapies, Chicago, IL.

Selby, E. M., McNeil, D. W., Marazita, M.L., & McCoy, M. (2006, February) Oral-

facial Clefts and Psychological Implications: Gender differences in fear of

negative and social evaluations. Poster presented at the 3rd

Annual

Undergraduate Research Day at the Capitol, Charleston, WV.

Selby, E. M., McNeil, D. W., Marazita, M.L., & McCoy, M. (2005, April) Oral-facial

Clefts and Psychological Implications: Gender differences in fear of negative and

social evaluations. Paper presented at the 14th

Annual Tri-State Psychology

Conference, Morgantown, WV.

Fluharty, K. K., Perry, J. E., Martins, R. M., Widoe, R. K., Selby, E. M., Kyle, B.K., &

McNeil, D. W. (2005, November). Acceptance in conjunction with distraction as

an effective approach to acute pain management. Poster presented at the 39th

Annual Convention of the Association for Behavioral and Cognitive Therapies,

Washington, DC.

Fluharty, K. K., Perry, J. E., Martins, R. M., Widoe, R. K., Selby, E. M., Kyle, B.K., &

McNeil, D. W. (2005, October). Acceptance in conjunction with distraction as

an effective approach to acute pain management. Poster presented at the 2005

Eberly College of Arts and Sciences Graduate Student Research Poster Session,

Morgantown, WV.

75


L., Fluharty, K. K., & Selby, E. M. (2005, March). Toward an understanding of

dental fear in Appalachia. Poster presented at the annual meeting of the

International Association for Dental Research, Baltimore, MD.


L., Fluharty, K. K., & Selby, E. M. (2005, February). Toward an understanding

of dental fear in Appalachia. Poster presented at the Eleventh Annual West

Virginia Section of the American Association for Dental Research: WVU School

of Dentistry Research Day, Morgantown, WV.

Perry, J. E., Fluharty, K. K., Davis, A. M., McNeil, D. W., Martins, R. K., Widoe, R. K.,

Helfer, A. J., & Selby, E. M. (2005, March). Coping with acute pain:

Implications for dental and medical procedures. Poster presented at the Annual

Undergraduate Research Day at the Capitol, Charleston, WV.

________________________________________________________________________

TEACHING EXPERINECE

Practicum Instructor for Adult Psychological Assessment Practicum, Marshall

University, Department of Psychology

Duration: Fall 2009, Spring 2009, Fall 2008, Fall 2007

Supervisor: Dr. Mulder

Duties: Lecture creation/preparation, classroom instruction, teaching of

psychological assessments (MMPI-2, MCMI-III, WAIS-IV, WMS-3, WRAT-3,

WIAT), grading of student assessment scoring ability, and supervision of student

assessment administration.

Teaching Assistant for Psychology as a Profession, West Virginia University,

Department of Psychology

Duration: Spring 2004

Supervisor: Dr. Jennifer Margrett

Duties: Lecture preparation, classroom instruction, activity preparation,

PowerPoint creation, tutoring, grading papers, facilitation of large-group

discussion, and clarification of course material.

Teaching Assistant for Research Methods in Psychology, West Virginia University,

Department of Psychology

Duration: January 9, 2006 – May 2006

Supervisor: Dr. Strouse; Rebecca Ryan (graduate student)

Duties: independent lecturing, attending lab sessions, correcting assignments,

tutoring and aiding students with APA style and assignments, lecture preparation,

grade entering etc.

________________________________________________________________________

GRADUATE ASSISTANTSHIP

Graduate Assistant: PsyD Program and Course Development Project

Location: Department of Psychology, Marshall University

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Duration: Summer, 2009

Duties: Creation of annual manuals the outline protocols for Psy. D. student

responsibilities and training experiences during each year in the program; creation

of course lectures, a syllabus, and protocol for future instructors of the Adult

Advanced Assessment Practicum Course; and creation of protocols for

completing doctoral comprehensive exams and portfolios.

Graduate Assistant on Undergraduate Psychology Advising Project



Duties: Undergraduate outreach, creation of Marshall University Undergraduate

Psychology Student Advising Manual (outlining the goals of program, the

responsibilities and requirements for majors and for graduation, mentorship

information, educational material regarding extracurricular activities in the

department, and information regarding professional and academic development),

creation of a user-manual for future advising staff working with undergraduate

psychology majors.

Graduate Assistant of Psi Chi (Psychology Honorary)


Duration: Spring, 2008

Duties: Undergraduate outreach, creation of Marshall University Psi Chi Chapter Manual

(outlining the goals of Psi Chi, the responsibilities of officers, and organizational

protocol), presentation of information about Psi Chi to undergraduates,

presentation of essential relevant information to undergraduates (taking the GRE,

making the most out of undergraduate school, and getting into graduate school),

creation of Psi Chi promotional materials (pamphlet, poster, board).

Graduate Assistantship for PsyD Coordinator

Graduate Assistant Supervisor: Dr. Marianna Footo-Linz


Duties: Compilation of PsyD orientation materials, participation in Psy. D.

orientation, and creation of materials for Head Start Consultation Program.

________________________________________________________________________

GRANTS

Eberly College of Arts and Sciences‟ Undergraduate Academic Enrichment Fund (2005

Fall and Spring Semester)

Eberly College of Arts and Sciences‟ Undergraduate Academic Enrichment Fund (2004)

OTHER FUNDING

The College of Liberal Arts (Graduate College and the Department of Psychology)

funded a trip to present research at the Convention for the Advancement of Behavioral

and Cognitive Therapies (ABCT) (Orlando, 2008)

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and Cognitive Therapies (ABCT) (Philadelphia, 2007)



and Cognitive Therapies (ABCT) (Chicago, 2006)

________________________________________________________________________

HONORS AND AWARDS

Recipient of the Health Sciences Scholarship (2009)

Recipient of the Madelein Feil Scholarship (awarded to the most active/productive

graduate students in the Marshall University Psy. D. Program), (2009)

Recipient of the Presidential Service Award (2007)

The Quin Curtis Award for Outstanding Undergraduate Student of 2006 (honor

acknowledging the most active, involved, and productive graduating student)

Recipient of the Presidential Service Award (2006)

Recipient of the Council on Undergraduate Research Acknowledgement of Achievement

in Research (2005)

Eberly College of Arts and Sciences‟ Academic Achievement Award (2004)

University of West Virginia, Member of the Psychology Honors Program (2004-2006)

Deans List, College of Arts and Sciences (2001 – 2006)

PROFESSIONAL HONOR SOCIETIES

West Virginia Psychological Association (WVPA (Fall 2008-present)

American Psychological Association, Student Affiliate (2004-present)

Association for Advancement of Behavioral & Cognitive Therapy, Student Affiliate

(2004-present)

PsyD Student Organized Advisory Panel (chair, member of core panel) (Fall 2008-2010)

PsyD Student Organized Advisory Panel (Secretary) (Fall 2007-Spring 2007)

Psi Chi, National Honor Society in Psychology (2004 – 2010), Vice President (2005 –

2006)

West Virginia University Psychology Club member (2001- 2006), Vice President (2005 –

2006)

________________________________________________________________________

ACTIVITIES

Student Representative of the PsyD Committee Board

Location: PsyD Program, Department of Psychology, Marshall University

Duration: January 2007 – 2010

Duties: Represent and communicate student concerns and preferences to faculty

and staff, participate in departmental development at the student and departmental

level, and facilitate communication between students and faculty.

78

Core Panel Psy. D. Student Organized Advisory Panel (Chair)

Duration: August 2008- 2010

Location: PsyD Program, Department of Psychology, Marshall University

Duties: Attendance of three monthly meetings, act as primary reporter to general

PsyD student body, communication of covered information to faculty in the PsyD

committee meetings, discussion of student issues, and strive to improve student

experiences and professional development.

Officer of Psi Chi, National Honor Society in Psychology (Vice President)

Location: Department of Psychology, West Virginia University

Duration: Summer 2005-Summer 2006

Duties: Attendance to weekly officer meetings, attendance to weekly faculty

advisor meetings, attendance to monthly membership meetings, participation in

service and departmental events and activities, creation of Psi Chi manual (aimed

to advance organization efficiency and progress), and collaborate with other

officers to carry out organizational demands.

Officer of Psy. D. Student Organized Advisory Panel (Secretary)

Duration: Fall 2004- Spring 2005

Location: Psy. D. Program, Department of Psychology, Marshall University

Duties: Attendance of monthly meetings, recordings of meeting discussion and

events, communication of covered information to faculty, discuss student issues,

and aim to improve student experiences and professional development.

________________________________________________________________________

REFERENCES

Dr. John C. Linton, Internship Director

West Virginia University School of Medicine

Department of Behavioral Medicine & Psychiatry

3200 MacCorkle Ave. S.E.,

Charleston, West Virginia 25304

(304) 388-1032

[email protected]

Dr. Marianna Linz

Position: Professor, Director of Clinical Training

Marshall University

One John Marshall Drive

Huntington, WV 25755

telephone: (304) 696-2774

E-mail: [email protected]

Dr. Donna Midkiff Position: Clinical Psychologist

River Park Hospital

440 13th Avenue

Huntington, WV, 25701

http://www.marshall.edu/www/emailform.asp?user=Linz

79

Telephone: 304-544-3457

Email: [email protected]

Dr. Pamela Mulder

Position: Professor, academic advisor

Marshall University

One John Marshall Drive

Huntington, WV 25755

Telephone: 304-696-2770

E-mail: [email protected]



Documents

The Application of the Lamaze Method in the Management of